Despite the profound and debilitating effects of Early Childhood Caries (ECC), and the extensive amount of resources spent to understand, treat and prevent it, it still remains one of the most common chronic childhood diseases, with nearly 1.8 billion new cases each year worldwide.
What we do know is that Early Childhood Caries is rapid, aggressive and painful. It affects children younger than age 6, and the majority of kids affected live in poverty. We know a bacteria that’s very difficult to control called Streptococcus mutans plays a vital role, and that it’s contagious. Blowing on food before feeding baby, sharing pacifiers and toothbrushes could be spreading it. In the U.S., children miss 55 million hours of school every year as a direct result of oral pain. Untreated cavities turn into painful infections, making it difficult to think, sleep and eat. And we also know there’s a 40 percent rate of recurrence.
Because treatment involves multiple tooth extractions and restorations, children are usually treated in the operating room under general anesthesia, at a cost of $8,000 per child. More than $1.5 billion is spent each year on ECC treatment, largely on the taxpayers’ tab. Last year, Eastman Institute for Oral Health (EIOH) pediatric dentists treated 953 children in the OR, compared to 820 cases the year before.
But Jin Xiao, DDS, PhD, an EIOH assistant professor, is looking at the problem from a different angle. She is studying the association between yeast infections and early childhood caries, thanks to a $300,000, two-year grant from the National Institute for Dental Craniofacial Research and National Center for Advancing Translational Research.
“We need to find a way to better identify high risk children as well as find more effective preventive strategies,” said Dr. Xiao, whose research interest has been focused on developing novel approaches to prevent and treat biofilm related oral infectious diseases, including dental caries.
“I’m studying to see if yeast, or C. albicans, may be the bigger, but easier to treat culprit,” Dr. Xiao said. “Over the past 10 years, there has been some initial research showing that yeast is present among ECC cases. More recent studies show yeast is prevalent in the oral cavity in 80-90% of children with ECC, compared to 15-20% of caries-free children.”
There are many kinds of yeasts, Dr. Xiao explained, noting that C. albicans is the most common strain that causes health problems. A little yeast in the body is not harmful. Too much can cause infections and other health problems.
Dr. Xiao will conduct a prospective cohort study, among 64 mother-infant dyads with socioeconomic disadvantages, study the pathological role of C. albicans in the onset of severe ECC, and its maternal influence. She will further clarify the association between C. albicans and other cariogenic bacteria and how they contribute to Severe ECC. Her study results will provide rationales of how and when to use antifungal treatment to prevent ECC.
“Our previous findings about the strong maternal influence on the presence of yeast in children’s mouths might open a new opportunity to prevent ECC during pregnancy,” Dr. Xiao said, “and could shift the current ECC preventive strategy to before birth.”
Her study may have a valuable impact on clinical practice by enabling an early caries risk assessment using fungal predictors, in addition to other existing ECC risk factors, and reduce the risk of ECC using an antifungal approach in infancy, long before tooth eruption, and to better prevent recurrence using antifungal approaches following traditional surgical caries removal.
Dr. Xiao was one of five scientists nationwide who were selected for the prestigious and highly competitive award. NIH’s National Institute of Dental and Craniofacial Research is collaborating with NCATS through the Clinical and Translational Science Awards Program to provide translational research training opportunities to oral, dental and craniofacial scientists early in their careers
“The CTSA Program hubs offer unique resources and expertise in translational research and team science,” said Lynn Mertens King, PhD, chief of NIDCR’s Research Training and Career Development Branch. “NIDCR supplements afford the oral, dental and craniofacial research community additional opportunities to participate in mentored clinical research career development and will help these scientists transition to an independent career.”